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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016445
Report Date: 08/14/2026
Date Signed: 08/14/2026 11:43:41 AM

Document Has Been Signed on 08/14/2026 11:43 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:KID TOWN USA PRESCHOOL-MONTESSORI ACADEMYFACILITY NUMBER:
198016445
ADMINISTRATOR/
DIRECTOR:		HARSHI ANTONYFACILITY TYPE:
850
ADDRESS:13500 PARAMOUNT BLVD.TELEPHONE:
(562) 630-0400
CITY:SOUTH GATESTATE: CAZIP CODE:
90280
CAPACITY: 144TOTAL ENROLLED CHILDREN: 73CENSUS: 56DATE:
08/14/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Ernestina CoronelTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
NARRATIVE
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On 08/14/2026 at 9:30AM LPA J.Duran arrived at the above facility to conduct a follow-up for an Unusual Incident that occurred on June 26. Census was taken and tour of the facility was conducted.
UIR stated at approximately 3:45 p.m. on Friday, June 26, Aaron was playing on the playground. While running near the blue slide, Aaron tripped and fell, striking his head. Miss Alex noticed Aaron and immediately made eye contact with him. When she saw that he was bleeding, both Miss Alex and Aaron quickly moved toward each other. Miss Alex promptly escorted Aaron to the office, where his injury was cleaned and he was assessed. Mrs. Valerie called 911 for medical assistance. At the same time, Miss Arely contacted Aaron's mother, Yvonne Padilla, to inform her of the incident and the actions being taken by the school. Paramedics assessed Aaron, and determined that he was stable. After speaking with the paramedics, Aaron's mother stated that she would transport Aaron to the hospital herself for further evaluation. As a result, transportation by ambulance was not necessary.
LPA J.Duran reviewed facility records, collected roster and interviewed child involved (C1). Per Director she did,not witness the incident herself and the teacher witness was absent for the day to interview.
LPA J.Duran toured the playground and found holes in the artificial turf on the playground where the big slides are. One type B deficiency was issued as this poses a potential health, safety or personal rights risk to persons in care. Per Director she will block off access to the big slides until artificial turf is fixed. LPA observed no children playing near the damaged turf. LPA Duran observed where, per C1 fell and hit his head and there were no hazards present.

A notice of site visit was given and must remain posted for 30 days.
Exit interview was conducted and report was reviewed with the Director, Ernestina Coronel.
Karen Chambers
Javier Duran
DATE: 08/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/14/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 08/14/2026 11:43 AM - It Cannot Be Edited


Created By: Javier Duran On 08/14/2026 at 10:26 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: KID TOWN USA PRESCHOOL-MONTESSORI ACADEMY
FACILITY NUMBER: 198016445

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/14/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/21/2026
Section Cited
CCR
101238.2(d)(2)

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Based on observtion, the facility playground has holes on its artificial turf which poses a potential health, safety and personal rights risk to persons in care.
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Per Director, they will block access tobig slides where damaged turf is and she will contact Administrator Antony Harshi to repair damaged turf. Director is to contact LPA Duran once turf is repaired no later than 08/21/2026.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Karen Chambers
NAME OF LICENSING PROGRAM MANAGER:
Javier Duran
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/14/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/14/2026


LIC809 (FAS) - (06/04)
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